| NPI | 1689281529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY G MODISETTE Owner/Operator 443-742-9167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2020-10-31 |